<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700997
Report Date: 08/22/2023
Date Signed: 08/22/2023 12:20:16 PM


Document Has Been Signed on 08/22/2023 12:20 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108



FACILITY NAME:VINE LEARNING CENTER #2, THEFACILITY NUMBER:
376700997
ADMINISTRATOR:SAMANTHA AGUIRREFACILITY TYPE:
830
ADDRESS:6705 LINDA VISTA ROADTELEPHONE:
(858) 715-1720
CITY:SAN DIEGOSTATE: CAZIP CODE:
92111
CAPACITY:58CENSUS: 51DATE:
08/22/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:51 AM
MET WITH:Samantah AguirreTIME COMPLETED:
12:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 08/22/2023 at 11:51am, Licensing Program Analysts (LPAs) Selina Siao and Gerald Poindexter made an unannounced case management inspection to follow up on an alleged incident that happened at the facility on 08/07/2023. Facility was contacted by a public agency on 08/09/2023 regarding a child in care and interviews were conducted with four staff members.

Facility did not report the unusual incident to licensing within the required 24 hours or submit the unusual incident report to licensing within 7 days.

See LIC809 for type B citation issue.

Exit interview conducted and report was reviewed with the Director. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 08/22/2023 12:20 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108


FACILITY NAME: VINE LEARNING CENTER #2, THE
FACILITY NUMBER: 376700997

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/25/2023
Section Cited
CCR
101212(d)

1
2
3
4
5
6
7
Reporting Requirements
Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours...follow up with written report within seven days
1
2
3
4
5
6
7
Director stated in the future she will be sure to contact licensing to report all unusual incidents within 24 hours and submit the written report to licensing within 7 days. Director will submit the written incident
8
9
10
11
12
13
14
This requirement is not met as on 08/09/2023, a public agency contacted the facility and spoke with four staff members regarding a possible incident that happened to a child in care. Facility did not report the unusual incident to the licensing office. This poses a potential health and safety risk to clients in care.
8
9
10
11
12
13
14
report to LPA Siao along with a written plan of correction no later than 08/25/2023.

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2